DESCRIPTION: (Applicant's Abstract) It is important to develop and evaluate more effective models of service outreach to homeless drug users who are at high risk of contracting and transmitting HIV and TB. The specific aims are: (1) Conduct a health, drug treatment and social needs assessment survey in a mainly homeless soup kitchen population, including medical conditions and infections (tests for HIV, TB, hepatitis-B, syphilis); drug/alcohol use and sexual behaviors. especially related to HIV risk; housing needs; educational, training and employment needs; mental health needs; and parenting needs (2) describe the social mechanisms of transmission of HIV, TB and other communicable diseases among homeless drug users in a soup kitchen population within high HIV seroprevalence community (3) Conduct a process evaluation of an existing service outreach network for homeless drug users located on-site in a large, inner-city soup kitchen (4) Conduct an outcome evaluation of the soup kitchen service outreach network, with the addition of Case Management assisted by Peer Consumer Advocacy as an experimental enhancement to the network. Peer assistance holds promise for improving outreach to disenfranchised populations. The primary target population for intervention will be homeless drug users who are current injectors or with injection histories. Study 1: Representative samples of male (N=150) and female (N=150) soup kitchen attendees will be interviewed, tested and described. This may be the first HIV/TB surveillance study based on a probability sample of homeless drug users found in a community setting within the Northeast, a high HIV/TB infection region. Study 2: Representative samples of male (N=200) and female (N=200) homeless drug users applying for health services, substance abuse treatment or social services at the soup kitchen will be randomly assigned to (a) Lead Case Manager with Peer Consumer Advocate, or (b) service "as usual," and followed-up for 6 months. Primary outcomes measured will include: receipt of medical and social services, reduced HIV risk behaviors; entry to substance abuse treatment; reduced drug use.